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A ProMED-mail post < http://www.promedmail.org>
ProMED-mail is a program of the International Society for Infectious Diseases < http://www.isid.org>

[1] Malaysia: human rabies
Date: Thu 3 Dec 2020 16:30 MYT
Source: Borneo Times via Malaymail.com [edited]


[1] マレーシア: ヒトの狂犬病

日付:2020年12月3日 木曜日 16:30 マレーシア時間

情報源: Borneo Times via Malaymail.com [編集済]
< https://www.malaymail.com/news/malaysia/2020/12/03/rabies-death-toll-in-sarawak-climbs-to-28-after-58-year-old-man-succumbs-to/1928507>

A 58-year-old man has been confirmed as the latest person to die of rabies in Sarawak this year [2020], said Health Director-General TanSri Dr. Noor Hisham Abdullah today [3 Dec 2020]. He also said another rabies case involving a 3-year-old boy was still receiving treatment for the disease and was reported to be in stable condition.


"With these 2 latest cases, the total number of rabies cases involving humans in Malaysia for the year 2020 has increased to 8 cases. Thetotal accumulative number of rabies cases in Sarawak since the rabies outbreak was declared in the state on 1 Jul 2017, now stands at 30cases with 28 fatalities.


"Only 2 cases are still alive, and both are children who received early treatment," he said in a statement today [see comment].


On the latest fatality, Dr. Noor Hisham said the deceased was admitted to the ward at Lundu Hospital on 19 Nov 2020 for 3 days followingsymptoms of body pain and weakness. He said the victim had also complained of a sore throat with difficulty in eating and drinking, before being transferred to Sarawak General Hospital (SGH) on 21 Nov 2020 when his health condition worsened.




"He passed away on 25 Nov 2020 and was diagnosed with rabies meningoencephalitis. The diagnosis was confirmed by a rabies positivelaboratory test by Institute of Medical Research (IMR) the same day. The deceased had a history of being bitten by a stray dog 2 years agowhile hunting in the jungle, but he did not seek immediate treatment at any health facility. The case also took care of 5 dogs, but these dogs have been confirmed negative for rabies by the Sarawak Veterinary Department," said Dr. Noor Hisham.

「患者は2020年11月25日に死亡し、狂犬病による髄膜脳炎と診断された。死亡同日に医学研究所(IMR)で実施された検査によって、狂犬病陽性と確定診断された。死亡した患者は、2年前にジャングルで狩りをしている最中に野良犬に噛まれた経歴があった。しかし、彼は、いずれの医療施設でも、すぐに治療を受けようとはしなかった。このケースでは他に5匹の犬について検査したが、これらの犬はサラワク州獣医局によって狂犬病陰性であることが確認された」 とヌール・ヒシャム博士は述べた。

The death is the 7th fatality from rabies in Sarawak this year [2020]. The previous case involved a 16-year-old girl who died at the SGH on11 Nov 2020 and was confirmed to be infected with the rabies virus the next day.

この症例は、今年(2020年)のサラワク州における、狂犬病による死亡者の7例目だった。 前のケースは16歳の少女で、2020年11月11日にSGHで死亡した。死亡翌日に、この少女が狂犬病ウイルスに感染していることが確認された。


On the other case involving a 3-year-old boy who is still alive, Dr. Noor Hisham said the case was bitten by a dog on the face on 2 Nov2020 before being immediately admitted to Bau Hospital to receive rabies immunoglobulin (RIG) injection and an anti-rabies vaccine.



"The case was discharged in good health on 6 Nov 2020. However, [from 13 to 15 Nov 2020], this child suffered high fever, weak limbs, poor appetite, restlessness, hydrophobia and showed aggressive behaviour. The case was admitted to SGH on 16 Nov 2020 for further treatment and confirmed to be infected with the rabies virus through laboratory tests conducted by the IMR on 25 Nov 2020. The child is now receiving treatment at the SGH and in stable condition. We at the Ministry of Health (MoH) pray for his speedy recovery," said Dr. Noor Hisham.

「この症例では、患者(3歳の男の子)は2020年11月6日に健康な状態で退院した。しかしながら、2020年11月13日から15日までの間、彼は高熱、手足の脱力、食欲不振、落ち着きのなさ、恐水症状に苦しみ、攻撃的な行動を示した。この患者は2020年11月16日にSGHに入院し、さらなる治療が行われ、IMRにて2020年11月25日に実施された実験室試験により、狂犬病ウイルスに感染していることが確認された。子供はSGHにて治療を受けており、容態は安定している。我々保健省(MoH )は、彼の迅速な回復を祈っている。」とヌール・ヒシャム博士は語った


According to him again, it was found that the child was bitten by a pet dog belonging to a neighbour while trying to save his grandmother's cat, which was attacked by the dog. "This dog was caught by the Bau District Council on 3 Nov 2020 and confirmed positive for rabies virus on 18 Nov 2020," he said.



Dr. Noor Hisham said deaths from rabies can be avoided if preventive measures are taken such as immediately seeking treatment at a nearby health clinic or hospital if bitten by animal. Those who are bitten by a dog or other animal must wash the bitten body parts with running water and soap for at least 15 minutes to remove the saliva, he said again.

ヌール・ヒシャム博士は、動物に噛まれた場合、すぐに近隣の診療所や病院で治療を求めるなどの予防措置を講ずれば、狂犬病による死亡を避けることができると述べた。 犬や他の動物に咬まれた人は、唾液を取り除くために、咬まれた部分を流水と石鹸で少なくとも15分間洗わなければならない、と彼はさらに述べた。

"Make sure your pet dogs have received anti-rabies vaccination every year from the nearest animal clinic and avoid having your pets mixing together with other dogs or wild animals. If a pet dog or cat is found to have a sudden change in behaviour, including becoming more aggressive, seek immediate treatment at a veterinary clinic and report to the nearest Veterinary Services Department. Also make a report to the local authority if there are stray dogs roaming in your area of residence," he added.


He also said MoH and Sarawak Health Department (JKN Sarawak) will continue to monitor the rabies situation in Sarawak. He added theywill share the latest related information to the Sarawak Department of Veterinary Services (DVS Sarawak) and DVS Malaysia to ensure that rabies prevention and control measures are implemented promptly and comprehensively.


"The cooperation of all Sarawakians is very much needed, by fully complying with all the advice from the government and the authoritiesto ensure that the problem of rabies in the state can be controlled. Do not let pets roam or dispose of them in public areas," he said.

「州内における狂犬病を確実に制御するために、すべてのサラワキア州の住民の協力が非常に必要である。それは政府と規制当局からのすべてのアドバイスを完全に遵守することにより達成される。ペットを公共の場所に徘徊させたり、棄てたりしないでください。 」と彼は述べた。


Communicated by:

[The 58-year-old man who died on 25 Nov 2020 had been initially admitted to a local hospital on 19 Nov 2020 and transferred, when hishealth condition worsened, on 21 Nov 2020 to the Sarawak General Hospital. The attribution of his rabies infection to a bite "by a stray dog in the jungle" (of which no further clinical information or fate is available) 2 years earlier, an extremely long period for rabies incubation, deserves to be viewed cautiously. His potential exposure to a rabid animal on rather a later date, most likely within the last 6 months, seems to have been considered by the authorities; hence, the information that "the case also took care of 5 dogs, but these dogs have been confirmed negative for rabies by the Sarawak Veterinary Department." This does not exclude the (plausible) possibility that a hitherto unrecognised animal was the true vector that infected the victim during the 6 months before the development of clinical signs. Having said this, it should be admitted that some, though rare, confirmed rabies cases in humans with very long incubation periods are found in the literature.

[2020年11月25日に死亡した58歳の男性は、2020年11月19日にまず地域の病院に入院したが、健康状態が悪化した後、2020年11月21日にサラワク州総合病院に転院した。 彼が狂犬病に感染した原因は、2年前にジャングルで野良犬に咬まれたことが原因と考えられているが、この野良犬の臨床症状や転帰についてこれ以上の情報がないこと、狂犬病の潜伏期間として非常に長いことから、注意して評価する必要がある。当局は、(この咬傷事故より)ずっと後に 、おそらく過去6か月以内に、狂犬病の動物に曝露された可能性があると考えたようである。それ故、「このケースについて他に5匹の犬を検査したが、サラワク州獣医局によって、いずれも狂犬病ではないことが確認された。」という情報が出された。


The history of the 2nd case, in a 3-year-old boy who apparently received his initial post-exposure treatment (RIG AND vaccine)immediately after exposure (which took place 2 Nov 2020), discharged "in good health" on 6 Nov 2020 but had to be re-admitted for renewed treatment on 16 Nov 2020, deserves further investigation that should include visiting the protocol of the initial treatment and themedicaments used.


Links to the 69 reports submitted to the OIE since the start of this rabies event in Borneo's East Malaysia (4 Jul 2017), and an interactive map presenting all 644 outbreaks in animals reported, are available at
< https://www.oie.int/wahis_2/public/wahid.php/Reviewreport/Review/viewsummary?fupser=&dothis=&reportid=24240>.
- Mod.AS




HealthMap/ProMED-mail map of Malaysia:
< http://healthmap.org/promed/p/147>]

[2] Bhutan: dog-transmitted fatal rabies case in an untreated young
Date: Wed 18 Nov 2020
Source: Outbreak News Today [edited]
< http://outbreaknewstoday.com/bhutan-human-rabies-death-reported-in-samtse-district-56608/>

[2] ブータン:犬から感染し、治療を受けることなく死亡した女の子の症例

日付:2020年11月18日 水曜日

情報源:Outbreak News Today [編集済]

According to a report in the Bhutanese news source, Kuensel, a 3-year-old girl from Lamjumsa village of Norbugang (Chengmari) gewogin Samtse died of rabies infection on 11 Nov 2020. The child died 2 months after a stray dog had bitten her. It is reported that although the parents were aware of the rabies risk, they did not take the child to the hospital after the exposure.


Rabies is an acute viral infection that is transmitted to humans or other mammals usually through the saliva from a bite of an infectedanimal. It is also rarely contracted through breaks in the skin or contact with mucous membranes.



According to the Control of Communicable Diseases Manual, all mammals are susceptible to rabies. Raccoons, skunks, foxes, bats, dogs,coyotes and cats are the likely suspects.



Initially, like in many diseases, rabies symptoms in humans are non-specific: fever, headache and malaise. This may last several days. At the site of the bite there may be some pain and discomfort. Symptoms then progress to more severe: confusion, delirium, abnormalbehavior and hallucinations. If it gets this far, the disease is nearly 100% fatal.

多くの病気と似て、発病初期におけるヒトの狂犬病の症状は、発熱、頭痛、倦怠感といった非特異的なものである。これらは数日間続く場合がある。受傷部位に痛みや不快感が現れることもある。 その後、症状は、錯乱、せん妄、異常行動、幻覚といった、さらに重篤なものへと進行する。この状態まで到達してしまうと、ほぼ100%致死的である。


What should do if you are exposed? First, clean the wound well with soap and water for 5-10 minutes. This will help reduce the chance ofgetting other bacterial infections, and some studies show it can reduce the likelihood of getting rabies. Next, get good description of the animal for Animal Control so it can be picked up for quarantine or rabies testing.

あなたが暴露された場合はどうすればよいか? まず、石鹸と水で5〜10分間傷口をよく洗う。これは他の細菌感染の可能性を減らすのに役立つ。また、いくつかの研究によれば、それが狂犬病に感染する可能性を減らすことが示されている。次いで、その動物に関する十分な情報を入手して動物管理部門に伝え、検疫または狂犬病検査のためにその動物を捕獲することができるようにする。


Go see your family physician or the emergency room. Though technically not a medical emergency, it is important to seek medical attention quickly so proper, timely treatment is given. If you have to shoot or otherwise kill the animal, take care not to damage the head. The brain will be required for rabies testing.

かかりつけの医師または救急病院に行くこと。厳密に言えば、医療上の緊急事態ではないが、適切な時期に適切な治療が行われるように、すみやか医師の診察を受けることが重要である。 動物を撃ったり殺したりする必要がある場合は、頭部を損傷しないように注意してください。 狂犬病の検査には脳が必要である。


Your doctor will evaluate the type of exposure (bite, scratch), and the type of animal that you had contact with. If post-exposure treatment is required, it will likely be a combination of human rabies globulin (HRIG) and rabies vaccine. The HRIG is given in one dose. RIG is basically pre-formed antibody that will provide immediate protection until you respond to the vaccine. The vaccine will help your body produce antibody to the virus, but this takes some time.

医師は、曝露の種類(咬傷、引っかき傷)、および接触した動物の種類を評価するだろう。 曝露後治療が必要な場合は、ヒト抗狂犬病イムノグロブリン(HRIG)と狂犬病ワクチンの組み合わせである可能性がある。HRIGは1回投与である。(H)RIGは原理的には、事前に形成された抗体であり、ワクチンによる免疫が成立するまでの期間に、速やかに防御能を付与する。(狂犬病)ワクチンによって(狂犬病)ウイルスに対する抗体が産生されるが、これには少し時間がかかる。

According to the CDC, the HRIG should, if possible, be given around the wound itself. Any remaining HRIG should be given intramuscularly away from the bite. Rabies vaccine is not like the old days, 20 shots in the stomach; instead, it is 4 shots in the shoulder area.


Communicated by: ProMED-mail <promed@promedmail.org>

[This description of a classic case of fatal rabies, illustrating the tragic results of neglecting timely post-exposure treatment, is self-explanatory. It deserves to become known to all parents in rabies-stricken countries, becoming a clear warning sign. - Mod.AS



HealthMap/ProMED-mail map of Bhutan:
< http://healthmap.org/promed/p/154>]

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